Total and cause-specific mortality in patients with personality disorders: the association between comorbid severe mental illness and substance use disorders

Abstract

Purpose To investigate the mortality in both in- and outpatients with personality disorders (PD), and to explore the association between mortality and comorbid substance use disorder (SUD) or severe mental illness (SMI). Methods All residents admitted to Norwegian in- and outpatient specialist health care services during 2009–2015 with a PD diagnosis were included. Standardized mortality ratios (SMRs) with 95% confidence intervals (CI) were estimated in patients with PD only and in patients with PD and comorbid SMI or SUD. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% CIs in patients with PD and comorbid SMI or SUD compared to patients with PD only. Results Mortality was increased in both in- and outpatients with PD. The overall SMR was 3.8 (95% CI 3.6–4.0). The highest SMR was estimated for unnatural causes of death (11.0, 95% CI 10.0–12.0), but increased also for natural causes of death (2.2, 95% CI 2.0–2.5). Comorbidity was associated with higher SMRs, particularly due to poisoning and suicide. Patients with comorbid PD & SUD had almost four times higher all-cause mortality HR than patients with PD only; young women had the highest HR. Conclusion The SMR was high in both in- and outpatients with PD, and particularly high in patients with comorbid PD & SUD. Young female patients with PD & SUD were at highest risk. The higher mortality in patients with PD cannot, however, fully be accounted for by comorbidity.

Association of Oxidative Stress–Induced Nucleic Acid Damage With Psychiatric Disorders in Adults

“…Severe unipolar depression is associated with a life expectancy decrease of 10 to 14 years . Personality disorders, substance use disorders, anxiety disorders, and posttraumatic stress disorder are also associated with increased mortality. The substantial impact of psychiatric morbidity on physical health is multicausal, with key contributors believed to be an unhealthy lifestyle, insufficient somatic care, metabolic side effects of psychotropic medications, and biological factors associated with the psychiatric disorder (eg, chronic neurohormonal stress) .…”

Suicide Risk in Personality Disorders: A Systematic Review

“…There was no discernible trend to distinguish between studies which did or did not report a significant association. Four studies measured suicide death as an outcome, with three reporting a significant association with PD [ 30 , 32 , 34 , 41 ]. Only Sumlin et al (2020) reported no association between PD and suicide death; however, the sample size of this study was considerably smaller ( N = 162) than that of the other three studies (range: from 14,103 to 54,350 participants).…”

Effect of comorbid ADHD on mortality in women with borderline personality disorder

“…Education level, obtained from the Participation in Education Register [ 25 ], was used as a proxy for socioeconomic status [ 26 ]. The analyses were also adjusted for year of birth, age at their first personality disorder diagnosis, parity, somatic and psychiatric comorbidity, and inpatient care as a proxy for severity as this is associated with a higher mortality risk than outpatient care alone in patients with personality disorders [ 21 , 27 ] (Table 2 ).…”

“…We have focused on women given that they are three times more likely to be diagnosed with clinical BPD than men [ 17 ] despite a similar population prevalence in both sexes [ 20 ]. Women diagnosed with BPD also have a higher risk of death, especially for unnatural causes of death [ 17 , 21 ]. Research shows that women with ADHD and BPD share more clinical features than men [ 14 ].…”